Illustration: Elena Scotti (G/O Media), Photo: AP

George Andrie, an original member of the Dallas Cowboys’ famed Doomsday Defense, had Stage 4 chronic traumatic encephalopathy at the time of his death last August at the age of 78, according to researchers at Boston University who posthumously examined his brain. Andrie’s diagnosis was confirmed by his daughter, Mary Brooks.

Andrie had suffered from dementia toward the end of his life. That he actually had CTE is another indication that the NFL concussion settlement keeps failing the people it’s supposed to help, or at least burdening many of those who seek relief. Last year, Brooks shared with Deadspin the multiple difficulties she experienced navigating the settlement’s claims process on her dad’s behalf—a problem faced by many other claimants. The settlement had been established to compensate former players for the years the league spent manipulating the data surrounding the effects of head trauma. Deadspin published Andrie’s story in May 2018, soon after his claim had been denied twice—the first claim evaluation had been riddled with mistakes, which resulted in a do-over after Brooks pointed those errors out—and an opportunity to appeal was granted.

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Andrie eventually received a monetary award a few weeks before his death on Aug. 21, 2018—albeit for an amount significantly lower than he was otherwise entitled, and not before Brooks had to swim through an additional layer of bureaucratic muck to get the league to finally cut a check.

Brooks believes the NFL and the settlement’s claims administrator found a way to get her dad an approval to keep her quiet.

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“They threw me a bone to shut me up,” she told me. “They got to put it on their books they paid another claim. Which makes them look good.”

CTE can only be definitively identified after death. Because Andrie remained relatively functional, even though he required a 24-hour caregiver, his daughter admitted she was “shocked” by the extent of the CTE the BU team found in his brain.

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“To me,” Brooks told Deadspin, “it’s remarkable how strong he was to overcome how bad it could have been.”

Andrie played defensive end for the Cowboys from 1962–72. A five-time Pro Bowler, he recovered a fumble for a touchdown in the famous Ice Bowl championship game against the Packers in 1967, knocked Johnny Unitas out of the game with a hit in Super Bowl 5, and won a ring in Super Bowl 6. He and his family chose to donate his brain to BU to learn more about what ailed him, and to contribute to the broader understanding of the relationship between football and repetitive brain injuries.

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Dr. Russ Huber, the director of BU’s PTSD Brain Bank, said the protein called tau, the characteristic marker of the CTE pathology, was present throughout Andrie’s brain, from the frontal cortex to the temporal cortex to the hippocampus, or memory center—“It was actually really bad in that [specific] area,” Huber said—all the way back to the brain stem.

“That’s why he would get the diagnosis of Stage 4,” Huber told Deadspin. “It was pretty advanced.” Brooks was more blunt. “This report,” she said, “would be in line with someone who’s a vegetable.”

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Asked to explain the discrepancy between Andrie’s relative functionality and the extent of the tau build-up that permeated so much of Andrie’s brain, Huber said: “Some people have more of what people would call a cognitive reserve. For whatever reason they have more resilience, it takes longer for the neurodegenerative disease to manifest. He may be one of those individuals that had that kind of cognitive reserve or resilience.”

In 2017, BU researchers published a study that found CTE in the brains of 110 out of 111 deceased former NFL players. But it’s important to stress that the study was not prospective, and that it was never meant to be viewed that way. The subjects were self-selected, and the study had a selection bias; like Andrie, all of the ex-players examined had exhibited symptoms associated with mood, cognitive, or behavioral disorders during their lifetimes. There was also no control group of non-football players, nor was there any consideration or analysis of additional factors like genetics, family history, drug and alcohol abuse, PED use, painkiller use, or smoking.

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Longitudinal studies aimed at sussing out a causal relationship between football and CTE are ongoing, and will take years to complete. Direct causation is also difficult to prove definitively. That said, repetitive brain injuries are known to be high-risk factors for the onset of a variety of brain diseases, and even despite the limitations of the BU study, the degree of risk that can be quantified is indeed somewhat worrisome.

Back to Andrie’s settlement claim. I promise the next two paragraphs are going to be confusing, and you should feel free to skip them, but there’s a point.

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A neurologist and a separate neuropathologist diagnosed Andrie with dementia in 2014. Under the terms of the settlement, any diagnoses made before the settlement’s effective date of Jan. 7, 2017, can be used to qualify for a claim award, provided that the diagnostic criteria was “generally consistent” with a more stringent post–effective-date standard. That determination is made by what’s known as the Appeals Advisory Panel (AAP), which simply reviews the documentation submitted by the claimant without actually seeing the patient. In April 2017, a third neurologist diagnosed Andrie with dementia, and that August a fourth one did the same under the auspices of approving Andrie for the NFL’s 88 Plan, which provides medical benefits to former players suffering from dementia, Alzheimer’s, and Parkinson’s. Those two 2017 diagnoses could not be considered for a pre–effective-date award, but even the two 2014 evaluations were not enough to get Andrie’s claim approved.

When Andrie finally was okayed to collect from the settlement fund, it was based on the August 2017 diagnosis. This was decided even though the settlement mandates an evaluation by one of two groups of settlement-approved physicians for any post–effective-date claims. Orran Brown, the Richmond, Va.-based attorney whose firm serves as the claims administrator, told Brooks in a phone call that the settlement also allows the AAP to make qualifying diagnoses after the effective date.

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Now try to imagine trying to navigate all this as a brain-addled player, or as a family member caring for a brain-addled player. And there were still more hurdles for Andrie and his family to clear.

The settlement has no cap, which has encouraged the NFL to work aggressively to limit its financial exposure. According to the latest claims report, 43 percent of all claims have been audited. The federal judge overseeing the settlement’s execution has largely sided with the league to create multiple safeguards to root out potential fraud, even at the expense of making the claims process more onerous for players and their families. In May, the court approved a new, more stringent set of physicians’ rules for post–effective-date claims. Soon afterward, that same judge removed all but one of the co-class counsels from the case, leaving Christopher Seeger—whom many plaintiffs’ attorneys feel has not been antagonistic enough toward the NFL—alone to represent the settlement class (and to collect the bulk of the legal fees, which top more than $100 million).

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The settlement pays claims based on death with CTE, ALS, Alzheimer’s, Parkinson’s, early dementia, and moderate dementia. Yet early and moderate dementia—which constitute a majority of claims submitted—are defined by the settlement in legal, rather than medical terms. Coupled with the fact that those suffering from early and moderate dementia can often seem to be clearheaded, it’s easy to see where there’s potential for fraud on one hand, and for players with legitimate neurocognitive impairment to get nickel-and-dimed by the process and by the NFL on the other.

The latter appears to be what happened with Andrie. Based on his age, a 2014 moderate dementia claim would have entitled him to a maximum of $158,000. As it was, he collected a pair of checks totaling $39,583.48—but only after his daughter had to clear three medical liens that had been placed on the award. Brooks said she never got any written breakdown of the liens, which totaled $148,520 and which would have ensured he collected nothing. It took her weeks of phone calls to get the whole thing cleared up so her dad could finally get paid.

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“I don’t know if you’ve ever tried to get a letter from an insurance company,” she told me, “but it’s not fun.”

But it was the process—the complications of submitting a claim, only to receive a denial full of errors, only to submit another claim and have that denied, then to appeal, then to learn that the claim was a significantly lower amount than promised, approved based on a standard for which Brooks was unaware, then to have to battle to get the liens cleared up—that to this day has Brooks angry. Her fight was never about the money, but about the obstacles many families—most of whom are far worse off than she is—have to overcome to get it.

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Early and moderate dementia claims account for 63 percent of those submitted. Just 23 percent of those early and moderate dementia claims have been approved for payment.

“I am sick to my stomach about how we had to do it,” Brooks said. “It makes me sick for the others because I know what I had to do to fight for [$39,000] for my dad and if that’s the way the thing goes down, everyone’s fucked. Everybody is absolutely fucked.”

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The CTE diagnosis did bring some closure, however.

“It’s what we knew, and it’s science, and no one can say it’s not real, and the NFL can’t deny it anymore,” Brooks said. “Of course, the NFL said Dad wasn’t sick at all.”